Democrats scale back 'doc fix' in pursuit of votes to pass jobs bill, Medicaid provision may be dropped

A bill that would, among other things, extend some unemployment benefits and provide a temporary fix for Medicare physician payment rates languished in the Senate Wednesday as a procedural vote to end debate on the bill failed, 52 to 45, The Wall Street Journal reports. Eleven Democrats broke with the party to vote no.

Senate Finance Committee Chairman Max Baucus announced changes to the bill Wednesday as Democrats tried to salvage part of the measure in the midst of bipartisan demands to lower the cost. "With support lacking, Democratic leaders moved to narrow benefit payments to unemployed workers (by dropping an extra $25 payment per unemployed worker per week) and pare a costly proposal that would suspend long-planned cuts in Medicare payments to physicians. Those changes alone would trim a little more than $20 billion from the legislation, which came with an original price tag of more than $120 billion, and would result in 'more than half' of the bill now being paid for, said Sen. Baucus."  (Hitt and Boles, 6/17).

The Associated Press: "Despite the loss, Democratic leaders predicted serenely that a scaled-back version of the measure — extending unemployment benefits for the long-term jobless and providing $24 billion in aid to the states — could pass, possibly as early as later this week, after relatively minor revisions." (Today's daily report includes summaries of additional coverage regarding the Medicaid funding provision.) There is definite urgency: Medicare "announced earlier this week that a 21 percent cut in reimbursements to physicians would take effect on Friday" (Taylor, 6/17).

CongressDaily: The slimmed-down bill has attracted at least one wavering Democrat: Sen. Evan Bayh. The bill saves more than $16 billion by postponing the Medicare physician payment cuts only through November "down from 19 months, putting the expiration of that provision on the same timeframe as the unemployment benefits" (Cohn, 6/17).

Los Angeles Times: "Resolving the impasse (over the larger bill) that has pitted deficit concerns against traditional social safety net programs provides an object lesson on how hard it is for Congress to legislate at a time when public anger over government spending is growing but the appetite and need for government programs has not waned" (Hook, 6/17).

Politico: "In the bargaining now, Senate Majority Leader Harry Reid, up for reelection in cash-strapped Nevada, is still holding onto a $24 billion, six-month extension of federal Medicaid assistance from January to June next year. The money is vital to the finances of states like Reid's, hit hard by the economic downturn, and he has the support of President Barack Obama. But the cost of the Medicaid funding makes the program an easy target, and the dollars may still have to be scaled back to win the swing vote of Snowe's fellow Maine Republican, Sen. Susan Collins" (Rogers, 6/17).

Chicago Tribune: In the meantime, the American Medical Association president-elect is preparing to battle Congress on the Medicare cuts, continuing the work of his predecessors. "'The AMA is going to be more insistent and a little edgier with its relationships with Congress and the administration in demanding some of the things we doctors need,' Dr. Peter Carmel (the incoming president) said in an interview with Tribune Newspapers. … Physicians say they are not making enough money on their existing Medicare patients and would be hesitant about accepting new ones if they are losing 21 cents on the dollar" (Japsen, 7/16).

And The New York Times reports that a new study shows that cutting the prices Medicare pays doctors and hospitals in order to reduce Medicare spending has limited success, especially if doctors try to make up for the lost income. "That is what happened, according to the study, after Congress tried to reduce Medicare spending on cancer chemotherapy drugs that doctors administer to patients in their offices. Many doctors ended up prescribing chemotherapy for more of their patients, to make up for the lower prices." The study will be published Thursday on the website of the journal Health Affairs. "On average, within a month of the diagnosis, chemotherapy treatment increased to 18.9 percent of patients, compared with 16.5 percent before the law went into effect in 2005" (Abelson, 7/16).